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ObjectiveTo longitudinally evaluate differences in HIV viral suppression (

The probability of having multiple chronic conditions simultaneously, or multimorbidity, tends to increase with age. Immigrants face a particularly high risk of unhealthy ageing. This study investigates the immigrant-native disparities in the speed of age-related chronic disease accumulation, focusing on the number of chronic health conditions; and considers the heterogeneity of this trajectory within immigrant populations by origin and receiving country. We use data from the Survey of Health, Ageing and Retirement in Europe from 2004 to 2020 on adults aged 50 to 79 from 28 European countries and employ both cross-sectional and longitudinal analyses. For longitudinal panel analyses, we use fixed-effects regression models to account for the unobserved heterogeneity related to individual characteristics including migration background. Our results indicate that immigrants report a higher number of chronic conditions at all ages relative to their native-born peers, but also that the immigrant-native differential in the number of chronic conditions decreases from age 65 onwards. When considering differences by origin country, we find that the speed of chronic disease accumulation is slower among immigrants from the Americas and the Asia and Oceania country groups than it is among natives. When looking at differences by receiving country group, we observe that the speed of accumulating chronic diseases is slower among immigrants in Eastern Europe than among natives, particularly at older ages. Our findings suggest that age-related trajectories of health vary substantially among immigrant populations by origin and destination country, which underscore that individual migration histories play a persistent role in shaping the health of ageing immigrant populations throughout the life course.

BackgroundIn March of 2013, the Los Angeles County (LAC) Division of HIV and STD Programs implemented a clinic-based Medical Care Coordination (MCC) Program to increase viral suppression (VS) (

The objective of this study was to assess monetary and non-monetary factors that can influence the decision to participate in a future health survey. A questionnaire was administered to eligible, low-income participants (n = 1502) of the 2012 Los Angeles County Health and Nutrition Examination Survey (LAHANES-II). Multivariable regression analyses were performed to describe factors potentially associated with future intent to participate in similar survey designs. The results of the survey suggest that, overall, female participants had a greater interest in participating under a variety of incentive scenarios. Compared to the 25-34 age group, older participants (35-44, 45-84) reported more interest to participate if $10 cash [prepaid gift/debit card], a coupon for product/travel, or a small item [e.g., granola bar, t-shirt, pen] was offered, whereas younger participants (18-24) reported greater interest for $25 cash or a coupon for product/travel. Non-Whites, when compared to Whites/Non-Hispanics, reported greater interest to participate if any of the incentives was offered. High school graduates, when compared to those with some college education, reported greater interest to participate if $10 cash, a small item, or a lottery ticket was offered. Presence of two or more chronic conditions increased interest while concerns about participation in LAHANES-II was associated with reduced interest to participate in future health-related surveys. The results suggest that both incentives and non-monetary considerations (e.g., personal concerns about participating and individual level characteristics) can influence the decision to participate in health-related surveys and offer insights into strategies that can improve response rates for these assessments that are often used to inform community planning.

Abstract Background Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. Methods CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP. Results Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%). Conclusions The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.

AimsStudies of environmental exposures and childhood leukemia studies do not usually account for residential mobility. Yet, in addition to being a potential risk factor, mobility can induce selection bias, confounding, or measurement error in such studies. Using data collected for California Powerline Study (CAPS), we attempt to disentangle the effect of mobility.MethodsWe analyzed data from a population-based case-control study of childhood leukemia using cases who were born in California and diagnosed between 1988 and 2008 and birth certificate controls. We used stratified logistic regression, case-only analysis, and propensity-score adjustments to assess predictors of residential mobility between birth and diagnosis, and account for potential confounding due to residential mobility.ResultsChildren who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status. Odds ratios for leukemia among non-movers living

BackgroundStudies have reported an increased risk of childhood leukaemia associated with living near high-voltage electric power transmission lines that extend to distances at which magnetic fields from lines are negligible. We conducted a large records-based case-control study of childhood leukaemia risk in the population living near power lines in California.MethodsThe study included 5788 childhood leukaemia and 3308 central nervous system (CNS) cancer cases (for comparison) born in and diagnosed in California (1986-2008), and matched to population-based controls by age and sex. We geocoded birth address and estimated the distance from residence to transmission lines using geographic information systems, aerial imagery, and, for some residences, site visits.ResultsFor leukaemia, there was a slight excess of cases within 50 m of a transmission line over 200 kV (odds ratio 1.4, 95% confidence interval 0.7-2.7). There was no evidence of increased risk for distances beyond 50 m, for lower-voltage lines, or for CNS cancers.ConclusionsOur findings did not clearly support an increased childhood leukaemia risk associated with close proximity (

BackgroundWe conducted a large registry-based study in California to investigate the association between race/ethnicity and childhood leukaemia focusing on two subtypes: acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML).MethodsWe obtained information on 5788 cases and 5788 controls by linking California cancer and birth registries. We evaluated relative risk of childhood leukaemia by race and ethnicity of the child and their parents using conditional logistic regression, with adjustment for potential confounders.ResultsCompared with Whites, Black children had lower risk of ALL (OR=0.54, 95% CI 0.45 to 0.66) as well as children of Black/Asian parents (OR=0.31, 95% CI 0.10 to 0.94). Asian race was associated with increased risk of AML with OR=1.643, 95% CI 1.10 to 2.46 for Asian vs Whites; and OR=1.67, 95% CI 1.04 to 2.70 for Asian/Asian vs White/White. Hispanic ethnicity was associated with increased risk of ALL (OR=1.37, 95% CI 1.22 to 1.52). A gradient in risk of ALL was observed while comparing Hispanic children with both parents Hispanic, one parent Hispanic and non-Hispanic children (p Value for trend

We conducted a large epidemiologic case-control study in California to examine the association between childhood cancer risk and distance from the home address at birth to the nearest high-voltage overhead transmission line as a replication of the study of Draper et al. in the United Kingdom. We present a detailed description of the study design, methods of case ascertainment, control selection, exposure assessment and data analysis plan. A total of 5788 childhood leukemia cases and 3308 childhood central nervous system cancer cases (included for comparison) and matched controls were available for analysis. Birth and diagnosis addresses of cases and birth addresses of controls were geocoded. Distance from the home to nearby overhead transmission lines was ascertained on the basis of the electric power companies' geographic information system (GIS) databases, additional Google Earth aerial evaluation and site visits to selected residences. We evaluated distances to power lines up to 2000 m and included consideration of lower voltages (60-69 kV). Distance measures based on GIS and Google Earth evaluation showed close agreement (Pearson correlation >0.99). Our three-tiered approach to exposure assessment allowed us to achieve high specificity, which is crucial for studies of rare diseases with low exposure prevalence.

Objectives: There is growing concern about how participating in longitudinal studies affects participants. However, assessments of survey participation effects on objectively measured behaviors are scarce. This study addresses this gap by assessing whether there is a relationship between participating in a longitudinal survey and respondents’ registered doctor’s visits. Methods: We used register-linked data from the Danish part of the Survey of Health, Aging and Retirement in Europe, a biennial panel survey of adults aged 50+, to assess whether survey participation is associated with changes in self-reported and actual doctor’s visits. Results: Neither self-reported nor register-recorded doctor’s visits significantly differed by survey participation. Observed increases in doctor’s visits over time are likely age-related. Discussion: Our findings add to literature about survey participation effects, suggesting that they may not be present for either self-reported or objective measures of this important health behavior.

ObjectivesTo measure the use of healthcare services and assistive devices by centenarians in five countries.DesignCross-sectional study using a survey questionnaire.SettingCommunity-dwelling and institutionalised centenarians living in Japan, France, Switzerland, Sweden and Denmark.Participants1253 participants aged 100 or in their 100th year of life, of whom 1004 (80.1%) were female and 596 (47.6%) lived in institutions.Main outcome measuresRecent use of medical visits, nursing care at home, home-delivered meals, acute care hospital stays overnight, professional assessments such as sight tests, mobility aids and other assistive devices. A set of national healthcare system indicators was collected to help interpret differences between countries.ResultsThere was considerable variability in the healthcare services and assistive devices used by centenarians depending on their country and whether they were community-dwelling or institutionalised. In contrast to the relatively homogeneous rates of hospitalisation in the past year (around 20%), community-dwelling centenarians reported widely ranging rates of medical visits in the past 3 months (at least one visit, from 32.2% in Japan to 86.6% in France). The proportion of community-dwellers using a mobility device to get around indoors (either a walking aid or a wheelchair) ranged from 48.3% in Japan to 79.2% in Sweden. Participants living in institutions and reporting the use of a mobility device ranged from 78.6% in Japan to 98.2% in Denmark.ConclusionsOur findings suggest major differences in care received by centenarians across countries. Some may result from the characteristics of national healthcare systems, especially types of healthcare insurance coverage and the amounts of specific resources available. However, unexplored factors also seem to be at stake and may be partly related to personal health and cultural differences.

BackgroundPopulation aging will pose huge challenges for healthcare systems and will require a promotion of positive attitudes towards older people and the encouragement of careers in geriatrics to attract young professionals into the field and to meet the needs of a rapidly growing number of old-aged patients. We describe the current demographic profile of hospital care use in Denmark and make projections for changes in the patient profile up to 2050.MethodsThe Danish population in 2013 (N = 5.63 million) was followed up for inpatient and emergency admissions recorded in Danish hospitals in 2013 using population-based registers. We combined age- and sex-specific hospital care use in 2013 with official population estimates to forecast the profile of hospital days up to 2050 with respect to age and sex.ResultsThe total number of hospital days per year is projected to increase by 42% between 2013 and 2050, from 4.66 to 6.72 million days. While small changes are projected for the population aged 0-69, the largest change is projected to occur for the population aged 70+. The 2013 levels were 0.82 and 0.93 million days for men and women aged 70+, respectively. By 2050, these levels are projected to have reached 1.94 and 1.84 million days. While the population aged 70+ accounted for 37.5% of all days in 2013, its contribution is projected to increase to 56.2% by 2050.ConclusionOur study shows one possible scenario for changes in the hospital days due to population aging by 2050: Assuming no changes in hospital care use over the forecast period, the absolute contribution of individuals aged 70+ to the total hospital days will more than double, and the relative contribution of persons aged 70+ will account for nearly 60% of all hospital days by 2050, being largest among men.

BackgroundPrevious pooled analyses have reported an association between magnetic fields and childhood leukaemia. We present a pooled analysis based on primary data from studies on residential magnetic fields and childhood leukaemia published after 2000.MethodsSeven studies with a total of 10,865 cases and 12,853 controls were included. The main analysis focused on 24-h magnetic field measurements or calculated fields in residences.ResultsIn the combined results, risk increased with increase in exposure, but the estimates were imprecise. The odds ratios for exposure categories of 0.1-0.2 μT, 0.2-0.3 μT and ≥0.3 μT, compared with

Before 1990, Germany was divided for more than 40 years. While divided, significant mortality disparities between the populations of East and West Germany emerged. In the years following reunification, East German mortality improved considerably, eventually converging with West German levels. In this study, we explore changes in the gender differences in health at ages 20–59 across the eastern and western regions of Germany using data from the German Socio-Economic Panel (SOEP) for the 1990–2013 period. We apply random-effects linear regressions to the SOEP data to identify trends in health, measured as self-assessed health satisfaction, after German reunification.The findings indicate that women were substantially less satisfied with their health than men in both West and East Germany, but that the gender gap was larger in East Germany than in West Germany. Furthermore, the results show that respondents’ satisfaction with their health decreased over time, and that the decline was steeper among men – and particularly among East German men – than among women. Thus, the initial male advantage in health in East and West Germany in the years immediately after reunification diminished over time, and even reversed to become a female advantage in East Germany. One interpretation of this finding is that stress-inducing post-reunification changes in the political and social landscape of East Germany had lasting damaging consequences for men’s health.Ongoing risky health behaviors and high levels of economic insecurity due to unemployment could have had long-lasting effects on the health of the working-aged population. A partial explanation for our finding that health declined more sharply among East German men than among their female counterparts could be that women have better compensatory mechanisms than men for dealing with psychosocial stress. Keywords: Gender Health Gap, German reunification, Health satisfaction, German Socio-Economic Panel

This study compares handgrip strength and its association with mortality across studies conducted in Moscow, Denmark, and England.The data collected by the Study of Stress, Aging, and Health in Russia, the Study of Middle-Aged Danish Twins and the Longitudinal Study of Aging Danish Twins, and the English Longitudinal Study of Ageing was utilized.Among the male participants, the age-standardized grip strength was 2 kg and 1 kg lower in Russia than in Denmark and in England, respectively. The age-standardized grip strength among the female participants was 1.9 kg and 1.6 kg lower in Russia than in Denmark and in England, respectively. In Moscow, a one-kilogram increase in grip strength was associated with a 4% (hazard ratio [HR] = 0.96, 95% confidence interval [CI]: 0.94, 0.99) reduction in mortality among men and a 10% (HR = 0.90, 95%CI: 0.86, 0.94) among women. Meanwhile, a one-kilogram increase in grip strength was associated with a 6% (HR = 0.94, 95%CI: 0.93, 0.95) and an 8% (HR = 0.92, 95%CI: 0.90, 0.94) decrease in mortality among Danish men and women, respectively, and with a 2% (HR = 0.98, 95%CI: 0.97, 0.99) and a 3% (HR = 0.97, 95%CI: 0.95, 0.98) reduction in mortality among the English men and women, respectively.The study suggests that, although absolute grip strength values appear to vary across the Muscovite, Danish, and English samples, the degree to which grip strength is predictive of mortality is comparable across national populations with diverse socioeconomic and health profiles and life expectancy levels.

Background: Women earn less than men at most career stages. Explanations for a gender gap in wages include gender differences in the allocation of household and domestic work. At the family level, a marital age difference is an important shared characteristic that might play a role in determining a woman's career trajectory, and, therefore, her income. Since women tend to marry older men, we investigate whether women whose husbands are older have lower incomes than women whose husbands are the same age or younger. Objective: This study investigates whether the age gap between a woman and her partner was associated with her income in Denmark in 2010. Methods: We use data on Danish female twin pairs in 2010. Our design includes samples within twin pairs (n = 4,716) and pooled twin samples (n = 13,354) to account for differences in early household environments and uses unconditional quantile regression to model the association between the age gap and the woman's income. Results: We find a statistically significant association between the marital age gap and the woman's income. The form of this association appears to be complex and varies across the income and age gap distribution. However, the magnitude of the estimated effects is small in economic terms. Conclusions: These results suggest that the marital age gap is unlikely to be an important determinant of a woman's income, at least in Denmark. Contribution: To our knowledge, this is the first study that explores the association between marital age differences and a woman's earnings using a twin design and high-quality register data.